| National Provider Identifier [NPI]: | 1487741328 |
| Last Name Of The Provider | HJELMSTAD |
| First Name Of The Provider | TRACY |
| Middle Initial Of The Provider | A |
| Credentials Of The Provider | DPM |
| Gender Of The Provider | M |
| Entity Type Of The Provider | I |
| Street Address 1 Of The Provider | 15318 N MAY AVE |
| Street Address 2 Of The Provider | |
| City Of The Provider | EDMOND |
| Zip Code Of The Provider | 730138864 |
| State Code Of The Provider | OK |
| Country Code Of The Provider | US |
| Provider Type Of The Provider | Podiatry |
| Medicare Participation Indicator | Y |
| Number Of HCPCS | 45 |
| Number Of Services | 778 |
| Number Of Medicare Beneficiaries | 177 |
| Total Submitted Charge Amount | 96012.44 |
| Total Medicare Allowed Amount | 55687.09 |
| Total Medicare Payment Amount | 41703.64 |
| Total Medicare Standardized Payment Amount | 45156.08 |
| Drug Suppress Indicator | |
| Number Of HCPCS Associated With Drug Services | 3 |
| Number Of Drug Services | 216 |
| Number Of Medicare Beneficiaries With Drug Services | 11 |
| Total Drug Submitted ChargeAmount | 7524 |
| Total Drug Medicare AllowedAmount | 5464.5 |
| Total Drug Medicare PaymentAmount | 4284.15 |
| Total Drug Medicare Standardized Payment Amount | 4284.15 |
| Medical SuppressIndicator | |
| Number Of HCPCS Associated With MedicalServices | 42 |
| Number Of Medical Services | 562 |
| Number Of Medicare Beneficiaries With Medical Services | 177 |
| Total Medical Submitted Charge Amount | 88488.44 |
| Total Medical Medicare Allowed Amount | 50222.59 |
| Total Medical Medicare Payment Amount | 37419.49 |
| Total Medical Medicare Standardized Payment Amount | 40871.93 |
| Average Age Of Beneficiaries | 73 |
| Number Of Beneficiaries Age Less65 | 27 |
| Number Of Beneficiaries Age 65 to 74 | 79 |
| Number Of Beneficiaries Age 75 to 84 | 42 |
| Number Of Beneficiaries Age Greater 84 | 29 |
| Number Of Female Beneficiaries | 102 |
| Number Of Male Beneficiaries | 75 |
| Number Of Non Hispanic White Beneficiaries | 151 |
| Number Of Black or African American Beneficiaries | 12 |
| Number Of AsianPacific Islander Beneficiaries | |
| Number Of Hispanic Beneficiaries | |
| Number Of American Indian Alaska Native Beneficiaries | |
| Number Of Beneficiaries With Race Not Else where Classified | |
| Number Of Beneficiaries With Medicare Only Entitlement | 142 |
| Number Of Beneficiaries With Medicare Medicaid Entitlement | 35 |
| Percent Of With Atrial Fibrillation | 14 |
| Percent Of With Alzheimers Disease or Dementia | 13 |
| Percent Of With Asthma | 10 |
| Percent Of With Cancer | 8 |
| Percent Of With Heart Failure | 24 |
| Percent Of With Chronic Kidney Disease | 27 |
| Percent Of With Chronic Obstructive Pulmonary Disease | 14 |
| Percent Of With Depression | 29 |
| Percent Of With Diabetes | 38 |
| Percent Of With Hyperlipidemia | 45 |
| Percent Of With Hypertension | 67 |
| Percent Of With Ischemic Heart Disease | 36 |
| Percent Of With Osteoporosis | 6 |
| Percent Of With Rheumatoid Arthritis Osteoarthritis | 49 |
| Percent Of With Schizophrenia Other PsychoticDisorders | |
| Percent Of With Stroke | |
| Average HCC Risk Score Of Beneficiaries | 1.49 |